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High-sensitivity C-reactive protein This is a marker for inflammation, which slowly erodes blood vessels and other organs. In the past decade, a blood test for high-sensitivity C-reactive protein has changed the assessment of patients dramatically. If your hs-CRP is normal (usually less than 0.1 mg/dl), your arteries do not appear inflamed by your diet, lifestyle, or other risk factors. On the other hand, if your hs-CRP is elevated, something is wrong with your lifestyle or health, and we should identify and correct them. I order this exam on every patient at least once a year. Carotid Intimal Medial Thickness (CIMT) This test uses an ultrasound machine to see inside the major carotid artery in the neck, which connects the heart to the brain. When it�s diseased, it�s very likely that other arteries in your body are also diseased. How it works: The ultrasound shows the thickness of the inner two linings of the wall of the artery (called the intima and media). If these walls are getting too thick, it�s a sign of early atherosclerosis. The advantage of CIMT is that it uses ultrasound so there is no radiation risk. If the CIMT is in a normal range (approximately 0.7 mm or less based on age or a thin artery wall), the risk of blockages anywhere else in the body is very low. If the CIMT is 0.8 mm and up, it is time to make over your lifestyle. Who needs it: This test has received a high recommendation from the American College of Cardiology and there are more than 500 scientific studies that speak to its effectiveness. I recommend it to patients starting at age 50, but even earlier for people who smoke, have high cholesterol, or a family history of vascular disease. CIMT is only covered by some insurance plans. Clinics charge between $150 and $250 on average. Caveat: While many places own the equipment to do a CIMT, they don�t all have the special software package needed to measure the thickness of the carotid artery and compare it to a normal thickness. Ask if your health care provider will be doing the test with special software dedicated to measuring CIMT. EndoPAT Arteries are lined with a single layer of super cells called the endothelium, which keep the vessel resistant to injury and clotting and allow them to dilate to provide more blood flow when needed. Healthy arteries spring back quickly after being squeezed, for example, by a blood pressure cuff. Once the cuff is removed, blood flow doubles, triples, or even quadruples for a few seconds to a few minutes. Diseased arteries don�t do this. When blood vessels don�t spring back, it is a sign of something called endothelial dysfunction, which is one of the earliest signs of artery disease we can detect. How it works: A blood pressure cuff is placed on an arm and inflated for five minutes, while a special clip is placed on one finger of each hand. When the cuff suddenly releases, the blood flow should increase greatly in the hand of the cuffed arm, but not on the hand that was not. When Mayo Clinic researchers did this test on more than 250 people and tracked their health for six years, those with poor blood flow had a higher risk of heart attack or death. Who needs it: I recommend EndoPAT for people who just want to know where they stand, but also for those who already know they have heart disease. A patient with a stent who has a normal EndoScore is much healthier than a similar patient with a poor one. The test costs under $200, and it�s covered by most insurance plans. Caveat: It�s possible to have full-blown heart artery disease (and even to have undergone bypass surgery or stenting) and still have normal endothelial function. This is a good place to be for a heart patient, but it doesn�t mean you should ignore lifestyle changes. Homocysteine About 40 years ago, an astute doctor observed early artery damage in young children who had an elevated level of an amino acid called homocysteine. More research has shown that in adults, increased levels of homocysteine have also been associated with increased risk of vascular damage. A safe homocysteine level, determined by a blood test, is under 10 micromoles per liter and even better is under 8. I get very concerned when it is in the high teens or over 20 micromoles per liter. Patients with high levels can be treated with B complex vitamins, which is a pretty simple solution.